434411856-6-22-2022-07-CC-SYIP-CFMS9B-20220622134027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411856
Report Date: 06/22/2022
Date Signed: 06/22/2022 01:40:33 PM

Document Has Been Signed on 06/22/2022 01:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CONTRERAS, LINDA		FACILITY NUMBER:	434411856
ADMINISTRATOR:	CONTRERAS, LINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 710-9777
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 10	DATE:	06/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Linda Contreras		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Samantha Yip and Ted Trujilo conducted an unannounced Required- 1 Year inspection. LPAs met with Licensee Linda Contreras and explained the reason for the inspection. Present during today's inspection were Licensee, her assistant, and 10 children. A volunteered arrived shortly after. All adults present have cleared fingerprints. There is board to post required postings, such as license and notification of parent's rights. There is working phone in the home. The hours of operation are Monday through Friday 7AM to 5PM. Licensee does not carry daycare insurance. Licensee understands that she need to have parents to sign LIC 282: Affidavit Regarding Liability Insurance. LPA inspected the inside and outside of the home. The off-limit areas of the home are living/dining room, kitchen, laundry room, garage, and the entire upstairs. Disinfectant, cleaning supplies, and other items that could pose a risk for children. LPA reminded Licensee that anything that states to keep out of reach of children needs to be inaccessible to children, such as sanitizer spray, Clorax wipes, and hair spray. There are toys and equipment for children were age appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire drill was conducted on 06/13/2022. Licensee stated that there are no weapons, such as firearms, stored in the home. ---------------------continues on 809 dated 06/22/2022 page 2---------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CONTRERAS, LINDA	FACILITY NUMBER: 434411856
	VISIT DATE: 06/22/2022

NARRATIVE

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The front yard is used and is fenced. The backyard is off-limits and has a pool, which has a fence. There were no other bodies of water observed during today's inspection. LPAs observed there is a see-saw that was wobbly. Licensee stated that she ensure that the screw is tighten.

Licensee does not transport children, but understands that children cannot be left alone and unattended.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

--------------------continues on 809 dated 06/22/2022 page 3-----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CONTRERAS, LINDA	FACILITY NUMBER: 434411856
	VISIT DATE: 06/22/2022

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-------------------------continuation of 809 dated 06/22/2022 page 2---------------------------

A copy of facility roster was obtained. 13 files were reviewed during today's inspection. There were four children who did not have LIC 282: Affidavit Regarding Liability Insurance. LPA also observed that C-1 was also missing immunization records. Licensee stated that she will renew her daycare insurance and send proof to Licensing. LPA also stated that she will also send C-1's immunization records.

Licensee and her assistant's files were reviewed. Licensee and her assistant completed the mandated reporter training on 08/09/2021. Licensee and her assistant's CPR/1st Aid expired on 05/2022. Licensee stated that she will sign up for CPR/1st Aid and will send copy of card to Licensing. Immunization records for measles and pertussis were on file. Licensee stated that she will obtain TB test and immunization record for volunteers and send proof to Licensing.

The adults living in the home are Licensee, her spouse, and her daughter. Licensee also has one minor children. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee stated that she submit the following:
- TB test and Immunization records for volunteer
- proof of renewal of daycare insurance
- CPR/1st Aid card

As a results of this inspection, two deficiencies and one technical assistant was issued. Exit interview conducted and report was reviewed with the licensee, Linda Contreras. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 06/22/2022 01:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CONTRERAS, LINDA	FACILITY NUMBER: 434411856
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above. Licensee and her assistant expired on 05/2022, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/22/2022
	Plan of Correction
1 2 3 4	By POC 07/22/2022, Licensee stated that she will register to complete the CPR/1st Aid training and send proof to Licensing.

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above in. There were four children who did not have have form filled out in file, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/08/2022
	Plan of Correction
1 2 3 4	By POC 07/08/2022, Licensee stated that she will renew her daycare insurance and send proof to Licensing.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC809 (FAS) - (06/04)

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